Uterine Inversion

. Theonlystudytoassessadhesiolysisandinfertilityisasmall retrospective review. Among infertile women with otherwise unexplained infertility diagnosed with adnexal adhesions at laparoscopy, pregnancy rates after subsequent adhesiolysis bylaparotomywere32%at12monthsand45%at24months compared with 11% at 12 months and 16% at 24 months in womenleftuntreated(15).Inwomenfollowedforanaverage of 49 months after tubal surgery, term pregnancy rates were inversely correlated with adhesion scores at the time of the surgical procedure, as assigned using (...) Gynecol 2006;107: 263–8. 33. Buttram VC, Reiter RC. Uterine leiomyomata: etiology, symptomatology, and management. Fertil Steril 1981;36:433–45. 34. Berkeley AS, DeCherney AH, Polan ML. Abdominal myomectomy and sub- sequent fertility. Surg Gynecol Obstet 1983;156:319–22. 35. Tulandi T, Murray C, Guralnick M. Adhesion formation and reproductive outcome after myomectomy and second-look laparoscopy. Obstet Gynecol 1993;82:213–5. 36. Tulandi T, Hum HS, Gelfand MM. Closure of laparotomy incisions

3.5.1 Genital trauma 22 3.5.2 Cervical trauma 22 3.5.3 Uterine rupture 23 3.5.4 Uterine inversion 24 3.6 Tissue 25 3.7 Thrombin 26 3.7.1 Target results 26 3.7.2 Coagulopathy principles 27 3.7.3 Cross matched RBC not available 27 4 Massive haemorrhage 28 5 Postnatal care after PPH 29 References 30 Appendix A: Uterine atonia interventions 33 Appendix B: PPH drug and blood products 34 Acknowledgements 35 List of Tables Table 1. Postpartum haemorrhage definitions 7 Table 2. Incidence of PPH (...) during PPH 18 Table 18. Oxytocin 19 Table 19. Ergometrine 19 Table 20. Misoprostol 19 Table 21. 15-methyl prostaglandin F2 alpha (carboprost) 20 Table 22. Intractable bleeding 21 Table 23. Genital trauma 22 Table 24. Cervical trauma 22 Table 25. Uterine rupture 23 Table 26. Uterine inversion 24 Table 27. Tissue 25 Table 28. Blood products 26 Table 29. Laboratory values 26 Table 30. Coagulopathy principles 27 Table 31. Blood cell replacement 27 Table 32. Example MHP bleeding protocol 28 Table 33

, are managed in a high-volume hospital ( , ). It also has been noted that maternal mortality is inversely related to the population density of maternal–fetal medicine subspecialists at the state level ( ), although other factors, such as the presence of obstetrician–gynecologists, nurses, and anesthesiologists who have experience in high-risk maternity care, also may contribute to this trend. Although these findings provide support for an association between availability of resources and favorable maternal (...) . Examples of appropriate patients (not requirements) Any patient appropriate for level I care, plus higher-risk conditions such as severe preeclampsia placenta previa with no prior uterine surgery Level III (Subspecialty Care) Definition Level II facility plus care of more complex maternal medical conditions, obstetric complications, and fetal conditions Capabilities Level II facility capabilities plus advanced imaging services available at all times. ability to assist level I and level II centers

baseline risk, typically the pooled proportion of the event without the treatment across studies. When studies with one group receiving an intervention were included (e.g., case series), a pooled proportion of an event (and confidence intervals) was calculated across the studies using the generic inverse variance. For continuous outcomes, a mean difference or a standardized mean difference (when studies used different scales to measure an outcome) was calculated. For screen-and-treat recommendations

, and late gadolinium-enhanced imaging. Radiology, 1994. 193: 239. 103. Kim, J.K., et al. Bladder cancer: analysis of multi-detector row helical CT enhancement pattern and accuracy in tumor detection and perivesical staging. Radiology, 2004. 231: 725. 104. Yang, W.T., et al. Comparison of dynamic helical CT and dynamic MR imaging in the evaluation of pelvic lymph nodes in cervical carcinoma. AJR Am J Roentgenol, 2000. 175: 759. 105. Kim, S.H., et al. Uterine cervical carcinoma: evaluation of pelvic lymph (...) node metastasis with MR imaging. Radiology, 1994. 190: 807. 106. Kim, S.H., et al. Uterine cervical carcinoma: comparison of CT and MR findings. Radiology, 1990. 175: 45. 107. Oyen, R.H., et al. Lymph node staging of localized prostatic carcinoma with CT and CT-guided fine-needle aspiration biopsy: prospective study of 285 patients. Radiology, 1994. 190: 315. 108. Barentsz, J.O., et al. MR imaging of the male pelvis. Eur Radiol, 1999. 9: 1722. 109. Dorfman, R.E., et al. Upper abdominal lymph nodes

is helpful if there is clinical doubt about the diagnosis and to detect any atypical or malignant changes. Differential diagnosis “Mucosal” or erosive lichen planus is the main differential diagnosis. GvHd, inverse psoriasis, eczema, vitiligo (particularly difficult in children), morphea, plasma cell vulvitis/balanitis, VIN / PIN and SCCs may show clinical features resembling LS. If the diagnosis is in doubt, a vulval biopsy has to be performed.(Raj 2013) Infections and a contact dermatitis may

, and late gadolinium-enhanced imaging. Radiology, 1994. 193: 239. 103. Kim, J.K., et al. Bladder cancer: analysis of multi-detector row helical CT enhancement pattern and accuracy in tumor detection and perivesical staging. Radiology, 2004. 231: 725. 104. Yang, W.T., et al. Comparison of dynamic helical CT and dynamic MR imaging in the evaluation of pelvic lymph nodes in cervical carcinoma. AJR Am J Roentgenol, 2000. 175: 759. 105. Kim, S.H., et al. Uterine cervical carcinoma: evaluation of pelvic lymph (...) node metastasis with MR imaging. Radiology, 1994. 190: 807. 106. Kim, S.H., et al. Uterine cervical carcinoma: comparison of CT and MR findings. Radiology, 1990. 175: 45. 107. Oyen, R.H., et al. Lymph node staging of localized prostatic carcinoma with CT and CT-guided fine-needle aspiration biopsy: prospective study of 285 patients. Radiology, 1994. 190: 315. 108. Barentsz, J.O., et al. MR imaging of the male pelvis. Eur Radiol, 1999. 9: 1722. 109. Dorfman, R.E., et al. Upper abdominal lymph nodes

events and possible subsequent medicolegal judgments. Most ED deliveries require only basic equipment to cut and clamp the umbilical cord and dry and suction the infant. However, the ED should have additional equipment and trained staff available to care for a newborn requiring further resuscitation. Maternal complications of labor and delivery include obstetric trauma, postpartum hemorrhage, uterine inversion and rupture, amniotic fluid embolism, coagulation disorders, and infections. Many (...) % of cases) Requires a thorough, well lit exam: look in the vagine and rectal area. Look for uterine inversion, consider whether uterine rupture may have occurred. Tears and lacerations may involve the perineum, rectum, cervix, vagina, vulva, and urethra. ● Continue supportive care as above ● Repair any lacerations/tears Coagulopathy Usually is the case in women with severe hemorrhage despite investigating and treating the above causes. should be evaluated for disseminated intravascular coagulation (DIC

fields/arcs, via narrow spatially and temporally modulated beams, binary, dynamic MLC, per treatment session G6016 Compensator-based beam modulation treatment delivery of inverse planned treatment using 3 or more high resolution (milled or cast) compensator

the definition is used to specify a series of time-sensitive interventions. The current overall incidence of EOS in the United States is approximately 0.8 cases per 1000 live births. A disproportionate number of cases occur among infants born preterm in a manner that is inversely proportional to gestational age at birth. The incidence of EOS is approximately 0.5 cases per 1000 infants born at ≥37 weeks’ gestation, compared with approximately 1 case per 1000 infants born at 34 to 36 weeks’ gestation, 6 cases (...) is complex. EOS primarily begins in utero and was originally described as the “amniotic infection syndrome.” , Among term infants, EOS pathogenesis most commonly develops during labor and involves ascending colonization and infection of the uterine compartment with maternal gastrointestinal and genitourinary flora, with subsequent colonization and invasive infection of the fetus and/or fetal aspiration of infected amniotic fluid. This intrapartum sequence may be responsible for EOS that develops after

VBAC rates inversely are correlated with total cesarean rates; repeat cesarean deliveries are associated with increased morbidity over time; VBAC counseling in?uences uptake of attempted trial of labor. Unclear VBACratedependsonaccess; many hospitals do not meet standards or have chosen not to offer VBAC for risk management reasons; potential for downstream complications if incentivized for VBAC success. Yes Can use administrative data for VBAC rate and VBAC success rate. No TOLAC counseling Yes (...) . Transabdominal evaluation of uterine cervical length during pregnancy fails to identify a substantialnumberofwomenwithashortcervix.JMaternFetalNeonatal Med 2012;25:1682-9. 23.Friedman A, Srinivas S, Elovitz M, Wang E, Schwartz N. Can trans- abdominalultrasoundbeusedasascreeningtestforshortcervicallength? Am J Obstet Gynecol 2013;208:190-7. 24.Meis PJ, Klebanoff M, Thom E, et al. Prevention of recurrent preterm delivery by 17 alpha-hydroxyprogesterone caproate. N Engl J Med 2003;348:2379-85. 25.Orsulak MK

IM after birth of baby o Wait at least 1–3 minutes after birth or for cord pulsation to cease and then clamp and cut cord o Controlled cord traction and uterine guarding after signs of separation o Prolonged after 30 minutes · Physiological o Suitable for well women without risk factors o Placenta birthed by maternal effort/gravity o Oxytocin not administered o Clamp cord after pulsation ceased o No controlled cord traction o Prolonged after 60 minutes · If concern with cord integrity or FHR: o (...) · Provides mild analgesia and sedation 112 · Minimal toxicity · Fast acting with rapid elimination 112,114 · No effect on uterine contractility · No known fetal or neonatal effects 114,115 · Effective for labour pain 73,116 · Can assist relaxation (breathing techniques) Risk · Overdose causes respiratory depression o Risk increased when used with opioid · Associated with: o Vomiting, nausea, headache and dizziness 73,110,114,116 o Disorientation and claustrophobia 73 · Can be minimised by careful